COVID-19 Updates Colorado Department of Health Care Policy & Financing May 15, 2020 1
Overview Budget Update • Bonnie S ilva, Office of Community Living Director, HCPF Colorado Department of Public Health & Environment (CDPHE) Update • Greg S chlosser, Branch Chief, CDPHE New Guidance Nursing Facility Supplemental Payment Provider Resources • Bonnie S ilva, Office of Community Living Director, HCPF • Riley De Valois, Provider Fee Analyst, HCPF 2
Budget Timing and Outcomes • Difficult budget decisions in process. • May 6, JBC Analyst reviewed possible HCPF budget cuts. JBC approved approximately $201M TF , $102M GF HCPF reductions. JBC tabled items totaling over $270M TF . • May 11 - OS PB/ Administration presented "comebacks" to JBC • May 12 - Updated from March, revenue forecast shortfall increased from $3.2B to $3.4B for 2020-2021 FY . Increases to $4.9B for FY 2021-2022 • May 14 – JBC Analyst presented cuts against to JBC. Additional $67M TF , $19M GF cuts approved. Approximately $180 million TF in additional cuts tabled, with action expected later this week or early next week. • JBC asked the Department to come back with additional cut options. • Budget cut process will likely be iterative. 3
Examples of 5/14 JBC Budget Decisions • Reduced dental benefit from $1500 to $1000 • Approved P ACE 2.37% rate cut, as an alternative to P ACE enrollee freeze • Delayed Inpatient Residential S UD benefit 6 months • Rej ected add'l HCPF member service & compliance staff (44% + mbr growth) • Tabled hospital rate cut. Comeback due COB Monday (CHA collaboration) 4
Budget Further Timeline • General Assembly expected to reconvene and start on the Long Bill in the House the week of May 25 • Budget must be passed and signed into law by June 30 • As they become available, HCPF will post our proj ections, fact sheets and overviews on Colorado.gov/ hcpf/ legislator-resource-center • JBC Documents: http:/ / leg.colorado.gov/ content/ budget • JBC S chedule: http:/ / leg.colorado.gov/ j bc_schedule • JBC Audio: http:/ / leg.colorado.gov/ committee/ granicus/ 929571 5
Additional Federal $'s Needed for States 6
Update • S tate Emergency Operations Center (S EOC) • S urvey Priorities • Isolation Plan S ubmissions • HEMS D COVID-19 Blog 7
OM 20-055 New Guidance OM 20-056 OM 20-057 Issued OM 20-059 IM 20-021 All COVID-19 relat ed Memos can be f ound here: www.colorado.gov/ hcpf / long-t erm-services-and-support s-covid-19-response 8
OM 20-055 TITLE: COVID-19 GUIDANCE FOR NEMT PROVIDERS In order to prevent the spread of COVID-19 to those who may be at increased risk, the Department is implementing temporary requirements for NEMT providers: • NEMT drivers shall wear face coverings that meet the recommendations set forth by the CDC. • NEMT rides shall be limited to one member per vehicle. An exception to this requirement exists if the member requires an escort . • NEMT Drivers shall use disinfectant wi pes on areas and obj ects in the vehicle that may have come into contact by previous riders prior to picking up any subsequent ride. • NEMT Drivers shall follow basic hygienic steps – washing hands, avoiding close contact with those who are sick, avoid face touching, covering coughs and sneezes, cleaning and disinfecting surfaces, using hand sanitizer when necessary. Have tissues and hand sanitizer available in vehicles for passengers and drivers Link: OM 20-055 9
OM 20-056 TITLE: TARGETED CASE MANAGEMENT-TRANSITION COORDINATION (TCM-TC) GUIDANCE FOR TRANSITION COORDINATION ACTIVITIES DURING COVID-19 PANDEMIC • Provides guidance, specific t o Target ed Case Management –Transit ion Coordinat ion (TCM-TC), on t he federal requirement t hat st at es maint ain program eligibilit y for all members enrolled on March 18, 2020 t hrough t he end of t he mont h in which t he public healt h emergency ends • Out lines communicat ion and signat ure modalit y adj ust ment s and administ rat ive t imelines • Overview of housing voucher process and housing navigat ion collaborat ive act ivit ies • List s crit eria for det ermining if a discharge can occur and st eps for implement ing a discharge • S ummarizes post -discharge monit oring requirement s Link: OM 20-056 10
OM 20-057 TITLE: DAY PROGRAM SERVICE OPERATIONS UNDER COVID-19 SAFER AT HOME ORDER Informs Day Program S ervice Providers and Case Management Agencies of required provisions in the resumption of Day Program S ervices in a congregate setting. Applies to: Adult Day Services Day Habilitation Day Treatment for Prevocational Supported the Brain Injury Services Employment – Waiver Group • Effective May 11, 2020, Day Program providers may begin to provide services in their setting for those members who are not considered part of the “ Vulnerable Population” defined in the S afer at Home order Must comply with Local Ordinances and Variances, the S afer at Home Order, and the following requirements on the following slide It should be not ed t hat Day Program S ervices are not deemed an “ Essent ial Act ivit y” per t he S af er-at -Home order Link: OM 20-057 11
OM 20-059 TITLE: OPERATIONAL MEMO FOR PROVIDER-OWNED RESIDENTIAL SETTINGS REGARDING THE HANDLING OF FEDERAL COVID-19 STIMULUS PAYMENTS The economic stimulus is considered an advance payment of a refundable federal tax credit and is not countable income for the purposes LTC/ HCBS Medicaid eligibility and will not be a countable resource for 12 months Impacts on Patient Payments S NFs and ICF-IIDs: • S timulus payments shall not be considered in calculating patient payments. • Process for 5615s outlined in Memo ACF and S LP: • S timulus payments shall not be considered in calculating Post Eligibility Treatment of Income (PETI) cost allocations. GRS S and IRS S — Host Home: • S timulus payments shall not be considered in provider reimbursement calculations; all funds shall go directly to the resident or guardian, based on current processes in place for personal needs accounts. Additional detail around impact on personal needs accounts outlined in Memo Link: OM 20-059 12
IM 20-021 TITLE: INFORMATIONAL MEMO FOR SNFS REGARDING CMP USAGE FOR COMMUNICATION DEVICES • Recognizing t hat visit or rest rict ions may be difficult for resident s and families, CMS has developed t his application template for request s for t he use of Civil Money Penalty (CMP) Reinvestment funds t o provide resident s wit h adaptive communicative technologies. • All licensed nursing facilities may apply. • The Nursing Facilit y Innovat ions Grant Board will be accept ing and screening applicat ions as t hey are received. • Crit eria, applicat ion and inst ruct ions may be found here. • Prior t o filling out t he applicat ion, you will need to download and save it t o your deskt op. • Complet ed applicat ions can be submit t ed t o cdphe_nhib_grant s@ st at e.co.us Link: IM 20-021 13
Previous Guidance Case Management Agencies HCBS Providers Operational Changes Critical Incident Reporting for COVID-19 Long-term Care and Congregate Residential Guidance • OM 20-049 Settings • OM 20-044 • OM 20-035 • OM 20-027 • OM 20-017 Level of Care Changes • OM 20-034 Host Home Inspections • OM 20-053 HCBS Therapy Services • OM 20-037 • OM 20-036 • OM 20-020 • OM 20-045 Retainer Payments P AS RR Changes Guidance for Class B Providers • OM 20-039 • OM 20-043 • OM 20-023 CDASS Sick Time Changes to Benefits & Services • OM 20-047 (Table) Changes to Benefits & Services Rates • OM 20-046 (Table) Facilities and P ACE Telemedicine • OM 20-048 • Temporary Policy Flexibility in Hiring Infection Control And Training & Certification Non-medical Transportation • IM 20-019 Prevention of COVID-19 in • OM 20-038 • OM 20-031 Nursing Homes (CMS ) Rate Increase • CMS QS O-20-14-NH • OM 20-050 Telemedicine in Nursing Options Counseling Facilities • OM 20-054 All COVID-19 and LTS S related memos can be found here: • OM 20-032 www.colorado.gov/ hcpf/ long-term-services-and-support s-covid-19-response 14
COVID Supplemental Payment • In lieu of 8% per diem rate increase • $14.6 million in aggregate across all facilities • Based on facility's portion of paid Medicaid FFS days to total paid Medicaid FFS days for all facilities from CY2019 • Letters describing each facility's payment will be emailed today or Monday 15
COVID Supplemental Payment, cont. • Transaction Date for COVID S upplemental Payment Friday, May 22, 2020 Automatically deposited for those facilities with EFT authorizations on file with the Department Too late to switch to EFT as the transactions have already started processing Checks mailed on Tuesday May 19, 2020 16
COVID Supplemental Payment, cont. • Medicaid FFS Billing No changes, continue to bill the same iC reimbursement rate from the S FY 2019-20 Nursing Facility Provider Fee Program Overview letter dated July 10, 2019 17
Mitigate COVID-19 Prevalence in Nursing Homes CMS Issued Toolkit on S tate Actions to Mitigate COVID-19 Prevalence in Nursing Homes Includes examples and best practices in areas like cleaning/ disinfecting, testing, cohorting, etc. 18
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